Laparoscopic Surgery In Women Research Articles

Emergency department attendances for persistent pelvic pain are not reduced following laparoscopic surgery for women with or without endometriosis.

To explore the change in emergency department (ED) attendances for persistent pelvic pain (PPP) following laparoscopic treatment of endometriosis. A retrospective service evaluation was conducted on a convenience sample of 1 calendar year of elective gynaecological laparoscopies for PPP. Data were collected on ED visits for surgical complications, and for PPP in the 12 months prior to and following surgery. Of the 195 women undergoing laparoscopy, 30 had attended the ED owing to their PPP in the preceding year. Endometriosis was found and treated in 51% of the cohort and no cause for pain was found in the other 96 women. Eighteen women suffered postoperative complications. In the subsequent 12 months, 31 of the cohort attended the ED for PPP. Likelihood of unscheduled hospital visits for post-operative complications and for exacerbations of pain in the year prior to and following surgery was independent of the presence of endometriosis lesions. In a cohort of women living with PPP, laparoscopic surgery failed to reduce the need to attend the ED owing to their pain. Further investigation into interventions that can reduce the burden of pain on these women and the healthcare system is required.

Comparison between robotic and laparoscopic surgery in women over 65 years old with gynecological malignancies

Comparison between robotic and laparoscopic surgery in women over 65 years old with gynecological malignancies

Sexual self-efficacy and sexual quality of life before and after laparoscopic surgery in women with endometriosis lesions: A crosssectional study

BackgroundEndometriosis is one of the most common gynecological diseases and is associated with an increased risk of dyspareunia.Objective This study aimed to evaluate sexual self-efficacy (SSE) and sexual quality of life (SQOL) before and after laparoscopic surgery of endometriosis lesions.Materials and MethodsThis cross-sectional study measured the dependent variable by questionnaires before and after the surgery, and was performed with 36 women with endometriosis (aged 20-40 yr) who were referred to Arash hospital, Tehran, Iran between December 2018 and July 2019 using a convenience sampling method. Data collection tools included SQOL and SSE questionnaires, and a visual analogue scale. Data were collected before, and 3 and 6 months after laparoscopic surgery.ResultsOut of the 36 women included in this study, 91.7% had pelvic endometriosis and 8.3% had abdominal and pelvic endometriosis. 9 participants (25.0%) were in stages I or II of the disease, and 29 (75.0%) had endometriosis with higher involvement. The findings of the study showed a positive effect of laparoscopic surgery on SQOL and SSE in participants (p 0.001).ConclusionLaparoscopic surgery in cases of endometriosis can improve SQOL and SSE in affected women and improve dyspareunia.

Perioperative use of pain medications in vaginal versus laparoscopic pelvic organ prolapse surgery.

There has been renewed interest in the management of postoperative pain after benign gynecological surgery. The purpose of the study was to determine if the use of intraoperative and immediate postoperative pain medication differs between vaginal and laparoscopic surgery in women with pelvic organ prolapse. The study included women who had undergone pelvic organ prolapse repair between 2014 and 2019 in two tertiary care hospitals. We collected demographic data and pain medication used during and after surgery, including opioids, local anesthetics, gabapentin, ketorolac, ibuprofen, and acetaminophen. Data analyses were performed using STATA Version 16.1. A p value <0.05 was considered to indicate statistical significance. A total of 195 women were included in the study, with 98 in the vaginal and 97 in the laparoscopic group. Intraoperative opioid use in the two groups was similar (25 morphine milligram equivalent [MME], p = 0.34). However, women in the laparoscopic group received significantly more intravenous and local anesthesia (lidocaine: 60 vs 40mg; bupivacaine 49.6 vs 20ml, p < 0.001). Postoperatively, although women in the vaginal group required almost twice as many narcotics as those in the laparoscopy group (MME = 28 vs 15, p < 0.001), after controlling for confounders in the multivariate analysis, there were no differences in postoperative pain requirements between the two groups. Recovery time had a significant impact on opioid and acetaminophen use (p < 0.05). Use of pain medication was similar in the intraoperative and immediate postoperative period after pelvic organ prolapse surgery when comparing the vaginal and laparoscopic approaches after controlling for potential confounding factors.

Differential-diagnostic and therapeutic challenges in the management of ruptured corpus luteum cyst with undiagnosed intrauterine pregnancy in the early first trimester and ruptured ovarian pregnancy

Background: The similarities in clinical features between ruptured corpus luteum cyst (RCLC) with undiagnosed intrauterine pregnancy in the early first trimester (RCLC-P) and ruptured ovarian pregnancy are well established. However, the identification of differences between these two morbid conditions is important to determine the causes and manage the hemoperitoneum without devastation of pregnancy in RCLC-P. Furthermore, the pregnancy outcomes after laparoscopic surgery in women with RCLC-P are not recognized. Methods: Retrospective observational study of six women with RCLC-P and seven women with ruptured ovarian pregnancy. Results: All cases were referred under strong suspicion of ruptured ectopic pregnancy due to lower abdominal pain and positive urinary pregnancy test after spontaneous conception. The estimated median number of gestational weeks in RCLC-P (5 weeks) was significantly lower than that for ruptured ovarian pregnancy (7 weeks). At triage, the median serum levels of beta-human chorionic gonadotropin (β-hCG) were significantly lower in RCLC-P (592 IU/L) than ruptured ovarian pregnancy (3723 IU/L) (p = 0.01). In all six cases with RCLC-P, laparoscopic ovary-sparing surgery was performed. Among the four women who received postoperative supplementation of progesterone, uneventful vaginal delivery occurred at term in three cases. Conclusions: Early gestational age and lower serum β-hCG levels at triage, as well as non-declining levels of serum β-hCG on the day after surgery, were significant predictors of RCLC-P rather than ruptured ovarian pregnancy. Laparoscopic surgery was a feasible option for the management of RCLC-P with appropriate postoperative luteal support to achieve successful obstetric outcomes.

Perioperative Use of Pain Medications in Vaginal Versus Laparoscopic Pelvic Organ Prolapse Surgery

<h3>Study Objective</h3> To determine if the use of perioperative pain medications differs between vaginal versus laparoscopic surgery in women with pelvic organ prolapse. <h3>Design</h3> We compared the consumption of various pain medications (opioids, intravenous and local anesthetics, non-steroidals, acetaminophen and gabapentin) between vaginal hysterectomy with uterosacral suspension and laparoscopic supracervical hysterectomy with sacrocolpopexy during intraoperative and immediate postoperative period. <h3>Setting</h3> Tertiary care hospital within the US. <h3>Patients or Participants</h3> Women undergoing surgery for pelvic organ prolapse. <h3>Interventions</h3> Retrospective chart review. <h3>Measurements and Main Results</h3> A total of 195 women who underwent pelvic organ reconstructive surgery were included in the study, with 98 in the vaginal and 97 in the laparoscopic group. Duration of surgery was significantly shorter in the laparoscopy (versus vaginal) group (98 vs. 190 minutes, p<0.001), with less blood loss (30 vs. 100ml, p<0.001), and shorter hospital stay (7.05 vs. 20.8 hours, p<0.001). Intraoperative opioid use was similar between the groups (25 MME, p = 0.34). However, women in the laparoscopy group received significantly more intravenous and local anesthesia than in the vaginal group (lidocaine: 60 vs 40mg; bupivacaine 49.6 vs. 20 ml, respectively, p<0.001). Postoperatively, women in the vaginal group required almost twice as many narcotics as those in the laparoscopy group (MME=28 vs. 15, p<0.001). Postoperatively, the groups did not vary in term of ketorolac, ibuprofen, or gabapentin use. After controlling for covariates, postoperative opioid and acetaminophen use were no longer significantly different between the vaginal and laparoscopic groups; however, recovery time was the most significant confounder accounting for the difference across all types of pain medications used, p<0.001. <h3>Conclusion</h3> Women undergoing prolapse repair regardless of route require similar amount of opioid intraoperatively, but differ in use in the postoperative period. Use of non-opioid pain medication were similar between the groups was comparable.

2735 The Incidence of Abdominal Wall Adhesions at the Time of Laparoscopic Surgery in Women with or without Previous Surgery

Study Objective To compare the incidence of abdominal wall adhesions at the time of laparoscopic surgery in women with various surgical histories. Design REB approved prospective cohort study. Setting Surgical suite in an academic affiliated teaching hospital. Patients or Participants 283 women undergoing laparoscopic surgery for gynecological indications between June 2013 to November 2014 Interventions After informed consent was obtained, laparoscopic surgery was performed by the senior author (GV), baseline patient characteristics were recorded, and the presence and description of abdominal wall adhesions was documented. Adhesions were characterized as containing bowel, mesentery, or omentum. Patients previous surgical history was documented. Measurements and Main Results The mean (SD) of age, parity and BMIof women were 36.8 (+/- 7.6) years, 0.96 (+/- 1.1), and 27.8 (+/- 6.5) kg/m2, respectively. The incidence of abdominal wall adhesions in women with history of: no previous abdominal surgery- 1.9% (2/104); at least one previous laparoscopy- 2.0% (2/101, p=1.00); at least one low transverse laparotomy- 20.7% (11/53, p Conclusion The incidence of abdominal wall adhesions in women undergoing laparoscopic surgery is the same in those with or without previous laparoscopic surgery of any kind. The incidence is increased in those with previous laparotomy, including low transverse incision.

Management and Outcome of Heterotopic Pregnancy

Objective: The aim of this study was to investigate the clinical efficacy of laparoscopic surgery for women with heterotopic pregnancy. Method: The clinical outcomes of 12 patients with intrauterine and ectopic pregnancy undergoing laparoscopic operation were analyzed retrospectively. Results: The products of ectopic pregnancy were removed by laparoscopically. The median operation time was 12 minutes, and the average blood loss was 21.4 ml. There were no postoperative complications. The wounds recovered well in all cases. Among these women, ten delivered at term whereas two failed to continue their pregnancies, one had an abortion after 8 days of the surgery and another one had an abortion due to preterm premature rupture of the membrane at 15 gestational weeks. Conclusion: Laparoscopic surgery is an effective technique in successful management of heterotopic pregnancy.

Laparoendoscopic single-site versus conventional laparoscopic surgery for ovarian mature cystic teratoma.

ObjectiveTo compare the intraoperative and postoperative outcomes of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery in women with ovarian mature cystic teratoma.MethodsA retrospective review of 303 women who underwent LESS (n=139) or conventional laparoscopic surgery (n=164) due to ovarian mature cystic teratoma was performed. Intra- and postoperative outcomes were compared between the two groups.ResultsThere was no intergroup difference in age, body weight, height, body mass index, comorbidities, tumor size, bilaterality of tumor, or the type of surgery. However, more patients in the LESS group had a history of previous abdominal surgery (19.4% vs. 6.7%, P=0.001). Surgical outcomes including operating time (89 vs. 87.8 minutes, P=0.734), estimated blood loss (69.4 vs. 68.4 mL, P=0.842), transfusion requirement (2.2% vs. 0.6%, P=0.336), perioperative hemoglobin level change (1.3 vs. 1.2 g/dL, P=0.593), postoperative hospital stay (2.0 vs. 2.1 days, P=0.119), and complication rate (1.4% vs. 1.8%, P=0.999) did not differ between LESS and conventional groups. Postoperative pain scores measured using a visual analogue scale were significantly lower in the LESS group at 8 hours (P=0.021), 16 hours (P=0.034), and 32 hours (P=0.004) after surgery, and 32 of 139 patients (23%) in the LESS group and 78 of 164 patients (47.6%) in the conventional group required at least one additional analgesic (P<0.001).ConclusionLESS was feasible and showed comparable surgical outcomes with conventional laparoscopic surgery for women with ovarian mature cystic teratoma. LESS was associated with less postoperative pain and required less analgesia.

Anti-Müllerian hormone trend after laparoscopic surgery in women with ovarian endometrioma

Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts. Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to investigate the extent of the ovarian reserve damage after stripping technique of unilateral endometriomas, by dosing the Anti-Müllerian Hormone (AMH). This prospective study was conducted at the Center of Minimally Invasive Pelvic Surgery of the Department of Health of Woman and Child, University of Padua, from October 2010 to June 2012. Twenty-five women underwent excision of monolateral endometriosis ovarian cyst by stripping without accessing a bipolar coagulation and performing an intracortical suture. The AMH serum levels were estimated in the early proliferative phase of the cycle, before surgery (time 0), 24 h after surgery (time 1), the first menstrual cycle after surgery (time 2) and the third menstrual cycle after surgery (time 3). We found a nonstatistically significant decreases in serum AMH levels after surgical excision of the cysts. Our results suggest that an appropriate surgical technique, without the use of the bipolar coagulation of ovarian border, does not determine a significant reduction of ovarian reserve.

OP24.05: Intra‐ and inter‐observer reproducibility of Doppler ultrasound features in adnexal masses

borderline or cancer on histology, these women were deemed to have had unnecessary laparoscopic surgery. Results: 73 women were diagnosed with a total of 86 ovarian cysts. 66/73 (90.4%) women were selected for laparoscopy and 7 (9.6%) were selected for laparotomy. Two women who had benign ovarian cysts on TVS were found to have borderline on histopathology. On histological examination, 70 (81.4%) ovarian cysts were benign; 16 (18.6%) ovarian cysts were borderline/malignant ovarian cysts. The operation was successfully completed laparoscopically in 63/66 (95.5%) cases. The pre-operative TVS assessment predicted the successful outcome of advanced laparoscopic surgery with a sensitivity of 98.4%, specificity of 66.7%, PPV 95.5% and NPV 85.7%. Conclusions: Although the numbers are very small, a detailed preoperative TVS is essential in planning and predicting the feasibility of advanced laparoscopic surgery in women with adnexal lesions.

Choosing the Right Patient: Planning for Laparotomy or Laparoscopy in the Patient With Endometrial Cancer

Endometrial cancer remains the most commonly diagnosed gynaecologic cancer in North America. The staging and initial treatment of endometrial cancer involves surgery. Laparoscopic surgery is increasingly used as an alternative to laparotomy. Patient selection for laparoscopy can be optimized by examining factors involved in both the choice of surgical approach and the ultimate procedure performed. We wished to identify factors that might be barriers to laparoscopic surgery in women with endometrial cancer who had surgery performed by the gynaecologic oncology group at the Capital District Health Authority (CDHA) in Halifax, Nova Scotia. We conducted a retrospective review of the records of women with endometrial cancer, histologically confirmed preoperatively between 2005 and 2007, who underwent surgery at the CDHA. Between 2005 and 2007 in Nova Scotia, 428 cases of endometrial cancer were diagnosed, and 289 women with a preoperative diagnosis of endometrial cancer underwent surgery at the CDHA. Of these, 66.1% (191/289) underwent a planned laparotomy, and 33.9% (98/289) had a planned laparoscopy. The proportion of attempted laparoscopies increased from 21.9% to 57.1% (P = 0.002) over time, while there was no change in the conversion rate (P = 0.23). Patients with abnormal findings on pelvic examination were more likely to have a laparotomy (RR = 1.5; 95% CI 1.34 to 1.68). Independent predictors of laparoscopic conversion to laparotomy were age 75 years or over (P = 0.03) and non-endometrioid histology (P = 0.002). Our data identify age and non-endometrioid histology as independent factors for conversion of surgery for endometrial cancer from laparoscopy to laparotomy. With this information we can optimize patient selection for laparoscopic surgery. Patients undergoing a conversion to laparotomy do not have a significant increase in surgery time or perioperative morbidity.

Changes in serum anti-Müllerian hormone levels may predict damage to residual normal ovarian tissue after laparoscopic surgery for women with ovarian endometrioma

We measured serum anti-Müllerian hormone levels before and after surgery in women undergoing unilateral and monolocular cystectomy for benign ovarian diseases. Comparing to control benign cysts, we found a significant decline in serum anti-Müllerian hormone levels with consequent depletion of follicles in tissue specimens after surgery for women with ovarian endometrioma.

Clinical Analysis of Laparoscopic Surgery in the Treatment of 32 Cases of Endometrial Cancer

Objective To investigate the clinical outcome of laparoscopic surgery in women with endometrial cancer.Methods 32 patients who received laparoscopic surgery form February 2004 to December 2008 in Peking University People Hospital were retrospectively reviewed and compared with the patients received traditional laparotomy.Results The blood loss(345.31±276.60)ml vs(568.75±345.62)ml(P0.05),and lymph node counts 20.53±8.35 vs 30.41±11.17(P0.05)were significantly reduced in the laparoscopic group,but no significant difference in the operative time(P=0.375).The time of bowel function recovery(1.91±0.86)days vs(2.91±1.67)days(P0.01),and hospital stay(17.22±6.19)days vs(21.72±6.84)days(P=0.002),were also significantly reduced in the laparoscopic group.Postoperative complications such as pelvic lymph cyst and poor wound healing were more common in the laparotomy group.The progress-free survival rate,overall survival rate and recurrence rate are similar between the two groups.Conclusions Laparoscopic surgery is a minimally invasive surgery for the early stage endometrial cancer with less blood loss,fewer postoperative complications and long term prognosis of patients need to be studied.

The effectiveness of non-invasive complementary therapies in reducing postoperative nausea and vomiting following abdominal laparoscopic surgery in women: a systematic review.

Postoperative nausea and vomiting (PONV) are common adverse events following surgery and anaesthesia. The reported incidence is particularly high in patients undergoing laparoscopic surgery, ranging from 40-77%. PONV can be very distressing for patients and can result in unplanned readmission in ambulatory surgery. Antiemetics are only partially effective for both prophylaxis and treatment, can have adverse effects and in the case of the newer medications are expensive. The effectiveness of a number of complementary therapies in reducing the incidence of PONV continues to be investigated, given their relative ease of application, relatively low cost, lack of significant side effects, and patient interest and acceptability. The objective of this review was to determine from the available evidence the most effective non-invasive complementary therapies for reducing the incidence and/or severity of postoperative nausea and vomiting in women undergoing abdominal laparoscopies. A literature search was undertaken using: relevant health care databases (eg. AMED, CINAHL, MEDLINE/PubMed, Current Contents, Science Direct); databases of reports, theses, and conference papers (eg Dissertation Abstracts, Conference Papers Index, National Research Register [UK]); and major sources of evidence-based practice information (e.g. Cochrane Library, Agency for Healthcare Research Quality, and clinical trials databases or registers) between the years 1980 and 2007. In addition reference lists of relevant journal articles and selected web sites were checked. Randomised controlled trials and quasi-experimental studies investigating the effects of non-invasive complementary interventions on postoperative nausea and/or vomiting, and the need for rescue medication following abdominal laparoscopic surgery in women were considered for inclusion in the review. Trials with only a 'no-treatment' control group were not included. Assessment of the eligibility of studies for inclusion in the review and the methodological quality of eligible studies, and data extraction from included studies were undertaken independently by two reviewers. Odds ratios and relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where pooling of data was inappropriate, studies were considered separately and a narrative summary reported. Twenty-one studies involving a total of 2286 participants were included in the review. Thirteen studies investigated the effect of four interventions on PONV following gynaecological laparoscopy: ginger, acupressure, guided imagery and music. Eight studies examined the effect of two interventions on PONV following laparoscopic cholecystectomy: stimulation of acupoints by various means and oral carbohydrate rich beverage.Six trials with a total of 554 participants investigated the effectiveness of varying dosages of ginger powder (Zingiber officinale) following gynaecological laparoscopy. There is some limited evidence to support providing ginger in doses between 1g and 1.5g to prevent or reduce the level of nausea postoperatively and to reduce the need for rescue medication whereas there is currently no evidence to support either a lower or higher dosage, i.e. <1000mg or >1.5g. Ginger in this dosage range (1-1.5g) has not been demonstrated to be effective in preventing vomiting.Four trials, with a total of 399 participants, investigated the effectiveness of acupressure as prophylactic treatment for PONV in patients undergoing laparoscopic gynaecological procedures; two using the P6 acupoint on the lower arm and two using the Korean K-K9 acupoint on the hand. There is evidence that stimulation of the K-K9 acupoint is effective, however the evidence for stimulating the P6 acupoint in this group of patients is equivocal. Six trials involving 719 participants investigated the effectiveness of stimulation of acupoints in patients undergoing laparoscopic cholecystectomy. There is some evidence to suggest that acupressure or acustimulation at P6 may be somewhat more effective in reducing nausea and vomiting following this surgical procedure for male and female patients. One study with 186 participants (male and female) assessed the application of capsaicin ointment to the Korean hand acupressure point K-D2. The treatment demonstrated efficacy in both the early (0-6h) and later periods (6-24h) for both the reduction of PONV and the need for rescue antiemetics.In treating established PONV postoperatively there were two trials, with a total of 172 participants, examining one category of intervention - inhalation of isopropyl alcohol (IPA). These two trials focusing on laparoscopic gynaecological procedures produced strong evidence that the administration of IPA is much quicker in achieving a 50% reduction in the level of nausea than the antiemetic ondansetron; however there is no evidence that it reduces the need for rescue antiemetics. The remaining three trials, two investigating oral carbohydrate rich beverage and the other guided imagery and music, did not demonstrate that these interventions were effective. There is sufficient evidence to suggest that several of the interventions assessed could play a role in a multimodal approach to minimise PONV following abdominal laparoscopic surgery, albeit requiring further research to confirm that promise. The two interventions of note are the use of the Korean Hand acupoints for prophylactic purposes, particularly acupressure applied to the acupoint K-K9, and the use of impregnated pads for the inhalation of 70% isopropyl alcohol to treat established nausea in females. There is also some evidence to suggest that acupressure or acustimulation at P6 may be effective in reducing nausea and vomiting in patients (females and males) having a laparoscopic cholecystectomy.

The effectiveness of non-invasive complementary therapies in reducing postoperative nausea and vomiting following abdominal laparoscopic surgery in women: a systematic review

The effectiveness of non-invasive complementary therapies in reducing postoperative nausea and vomiting following abdominal laparoscopic surgery in women: a systematic review

Does the learning curve of conservative laparoscopic surgery in women with rectovaginal endometriosis impair the recurrence rate?

To assess the effect of surgeon's increasing experience in conservative laparoscopic surgery of women with rectovaginal endometriosis on the surgical outcome of these patients recurrence rate. Prospective cohort study. University teaching hospital. The first 60 consecutive patients undergoing laparoscopic conservative surgery for symptomatic rectovaginal endometriosis at our institution during a 4- year period. Cases were classified into two groups according to the date of the patient's operation: the first 30 cases were defined as the early cases and the subsequent 30 cases as the late cases. Operating time, perioperative complications, and surgical outcome. Univariate and multivariate analyses for risk factors with recurrence of disease. The two groups were similar in patient characteristics. There was a reduction in the rate of laparoconversion, operating time, estimated amount of blood loss, cases with incomplete removal, and recurrence rate with increasing surgeon's experience. Surgical completeness was significantly associated with recurrence of disease. A learning curve is demonstrated in the conservative laparoscopic management of patients with rectovaginal endometriosis. After gaining experience in performing 30 cases, the recurrence rate is significantly reduced.

Laparoscopic Surgery for Large Benign Ovarian Cysts

In previous studies of laparoscopic surgery for women with ovarian cysts, most patients had small cysts. The present prospective study evaluated the laparoscopic approach in 33 consecutive women operated on during a 7-year period for ovarian cysts having a maximum diameter of 10 cm or more. All had laboratory and radiological features suggesting benign disease. Participants ranged in age from 17 to 73 years, averaging 45 years. The mean body mass index was 30, with a range of 21 to 42. Prospective patients whose maximum cyst diameter exceeded 30 cm were excluded from the study. Laparoscopic surgery proved effective in all but 2 instances, for a success rate of 94%. Two patients with adhesions were converted to laparotomy. No surgical or postoperative complications were recorded. Operating time averaged 82 minutes, and estimated blood loss, 89 mL. The hospital stay averaged just under 1 day; more than two-thirds of patients were discharged on the day of surgery. The procedures most frequently performed were unilateral salpingo-oophorectomy (SO) and laparoscopically assisted vaginal hysterectomy with bilateral SO. Cysts were extracted by aspiration through the vagina in 11 cases, by a lower quadrant incision in 5, and via an umbilical incision in 15. The most common pathologic finding was serous cystadenoma, followed by mucinous cystadenoma, dermoid, endometriosis, benign epithelial-lined cyst, and-in 2 cases-borderline ovarian tumor. All 4 women who were pregnant at the time of laparoscopic surgery, from 14 to 18 estimated weeks of gestational age, had a good outcome. These findings support accumulating evidence that laparoscopic surgery is an effective and safe procedure for removing large benign ovarian cysts.

Analysis of Survival After Laparoscopic Management of Endometrial Cancer

Study Objective To assess the effect of laparoscopic surgery on the survival of women with early-stage endometrial cancer and to analyze the factors that affect survival. Design Retrospective cohort study (Canadian Task Force classification II-2). Setting Tertiary teaching hospital. Patients Women with clinical stage I and II endometrial cancer (International Federation of Gynecology and Obstetrics staging, 1971) from January 1993 through June 2003. Intervention Demographic, surgical, perioperative, and pathologic characteristics of women treated with laparoscopy or laparotomy were compared by use of Fisher’s exact test or the Student t test. Recurrence-free and overall survival was calculated by use of the Kaplan-Meier method. Stratified analyses were performed with the log-rank test for factors affecting survival (surgical stage, histologic study, and grade). Measurements and Main Results Sixty-seven and 127 women were treated with laparoscopy and laparotomy, respectively. Median follow-up was 36.3 months for the laparoscopy group and 29.6 months for the laparotomy group. The complication rates in the 2 groups were comparable. Women undergoing laparoscopy had shorter hospital stay and less morbidity related to infection. The 2- and 5-year estimated recurrence-free survival rates for the laparoscopy and laparotomy groups (93 % vs 91.7% and 88.5% vs 85%, respectively), as well as the overall 2- and 5-year survival rates (100% vs 99.2% and 100% vs 97%, respectively) were similar. Conclusions Laparoscopic surgery in women with early-stage endometrial carcinoma resulted in survival rates similar to laparotomy, although a small sample size precludes definitive conclusions. A larger randomized comparison of the 2 techniques is needed to validate these findings.

Changing trends in the laparoscopic management of ectopic pregnancy in a London district general hospital: 7-years experience

SummaryWe set out to evaluate the effect of a programme introduced in January 2003 to make operative laparoscopy the standard surgical treatment for women requiring surgery for ectopic pregnancy. This was a retrospective and prospective clinical data analysis performed at The Whipps Cross University Hospital in London, with a comparison of data taken before and after the introduction of the programme. A total of 116 women who had surgical management for ectopic pregnancy from January 2000 to December 2002 and 313 women who had surgery for ectopic pregnancy between January 2003 and December 2006 took part in the study. A programme was started in January 2003 to make operative laparoscopy the surgical management of choice. The main outcome measure was the proportion of women requiring surgery who had operative laparoscopy in the two study periods. The χ2-test was used to determine if there was any statistically significant difference between proportions. A difference was deemed statistically significant if p < 0.05. The results showed that there was a progressive rise in the proportion of ectopic pregnancies managed by operative laparoscopy following the change in January 2003. A total of 34% of women were managed laparoscopically between 2000 and 2002, increasing to 90% between 2003 and 2006. This difference was statistically significant (p < 0.001). In 2006, some 96% of women requiring surgery were managed by laparoscopic surgery. The findings of this study indicate that it is possible to implement changes which increase and sustain a high rate of laparoscopic surgery for women with ectopic pregnancy requiring surgery in a district general hospital setting.